The SANAC Civil Society Forum (CSF) welcomes the release of the NHI Bill and supports the objectives of the establishment of the NHI fund. Our submission to the NHI Bill is outlining our support and some changes we would like to see being included in the NHI Bill before it goes to Parliament for approval as a law of the Republic.

This Parliamentary process should not be delayed in order to satisfy private sector lobbyists. Parliamentarians serve at the behest of the people, and this Parliament should ensure that before its current term ends, it adopts the NHI Bill.

In preparing for the NHI Parliamentary process of public inputs and the Presidential Health Summit on 19 & 20 Oct 2018 which is linked to the NHI processes, we will be hosting a Preparatory High Level Meeting of the Civil Society Forum on 11 Oct 2018. This meeting will ensure that we crystalize our position as we advocate for more South Africans who depend on public health to receive quality and people-centred health services in line with Section 27 of the South African Constitution.

Our submission on the NHI, supported by our strategic linkages with COSATU[1] provides comprehensive assessment of the content of the NHI Bill and provided various proposals that strengthen the content of the current NHI Bill.

As SANAC Civil Society Forum, we have long called for implementation of universal health care system in South Africa. When the idea of the National Health Insurance (NHI) was introduced many years ago, we were very excited that our call for a universal health system will be realized. We didn’t know that many years later, we would still be talking, advocating and fighting for the NHI instead of seeing it being rolled-out. The delay was as a result of 2 stumbling blocks viz:

1. Private sector hell-bent maximizing profit by excluding the majority of South Africans, especially poor people from accessing health services through “stealing money meant for the public health system to subsidize private health system by sustaining apartheid era medical aid tax benefits. This has resulted in South Africa currently spending 8.5% of GDP on health care with the private sector spending 4.4% of GDP on health which benefits only 16% of the population.

2. Government kowtowing to the whims of the private sector and in the process failing in its duty to ensure that Section 27 of the Constitution is implemented, which simply enjoins government to provide quality health service to the population. This has resulted in South Africa currently spending 8.5% of GDP on health care with the public sector spending 4.1% of GDP on health care for 84% of the population.

The NHI is a platform to ensure the spirit and the letter of section 27 of the RSA Constitution and the Article 12 of the United Nations Convent on Economic, Social and Cultural Rights, 1966 are realized, where the private sector is happy or not happy. Transforming the South African society requires that we put people before profits.

SANAC Society Forum will continue to confront the highly racialised model of funding for the health in South Africa, as we are doing in terms of the HIV and TB response. We will continue fight against a system of funding that seeks to sustain an apartheid modus operandi that deepens inequalities along racial lines through patterns of development that restrict the lives of black South Africans. Communities must rise and confront Afro-pessimism agents, particularly those who have strategically placed themselves at the ‘centre’ of the health services on behalf of communities when in fact they are opponents of the values of the Constitution of South Africa and Agenda for Sustainable Development Goals – a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity.

The people, especially the African poor majority are most affected by HIV and TB, and they rely solely on the public health system for treatment. The NHI seeks to improve and support the public health system, and this will result in immense benefits for the people. With such an approach, we will see the people through their communities taking their place at the front, center and back of the their health needs, and by extension the response to end HIV and TB.

The SANAC CSF through this submission, we call for the redirection of health financing and accountability through the NHI to address community systems strengthening. This goes beyond the challenges confronted by the narrow bio-medical centred definition of health pursuing “absence of disease and infirmity” that is offered by current health systems (both public and private) through the administration of drugs, to the broader community capacity enhancement based definition of health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” At the centre of this approach is the NHI.

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